The importance of sunlight has been recognized since long. Ultraviolet light which comprises a small proportion of sunlight is therapeutically useful. Phototherapy is the use of ultraviolet irradiation with or without exogenous photosensitizer. It can be administered as photochemotherapy, Broadband UVB and narrowband UVB therapy, Excimer laser, UVA1 phototherapy and photodyanamic therapy. In India, photochemotherapy and narrowband UVB therapy are widely used for treatment of various dermatological problems. This article discusses the treatment protocols and the various modalities of treatment by phototherapy.

Background: Pemphigus is an autoimmune blistering disease of the skin and mucous membranes with significant mortality and morbidity. Genetic factors are known to be involved in pemphigus. Several studies have reproducibly shown significant associations of ABO blood groups with various autoimmune human diseases. Aim: To study the relationship between ABO and Rhesus (D) blood groups and pemphigus in Iranian patients. Materials and Methods: Data on age, sex, ABO and Rhesus blood type and clinicopathological diagnosis of the patients with pemphigus were collected. A total of 573 patients with pemphigus were assessed for their association with ABO or Rhesus (D) blood groups and compared with the normal population in the area. Results: The distribution of ABO and Rhesus blood groups in patients with pemphigus was similar to the normal local population in Iran. No relationship was found between ABO or Rhesus blood groups and the phenotype of pemphigus. Conclusion: It appears that there is no association between ABO or Rhesus (D) blood groups and the frequency of pemphigus variants in comparison with normal population in Iran.

Introduction: Acne vulgaris, a disorder of the pilosebaceous structure, is a common disorder in adolescents and young adults that is associated with significant morbidity. Aim: The aim of this study was to compare the effects of the drugs adapalene and azithromycin, given separately and in combination in acne vulgaris. Methodology: A total of 61 newly attending cases of inflammatory acne vulgaris were considered the study. They were randomly allocated into three groups. Group 1 received topical adapalene (0.01%) gel, group 2 received oral azithromycin, whereas group 3 was given a combination of these two. The patients were treated for a period of 12 weeks, being reviewed every fortnightly. The results obtained were analyzed in detail using statistical methods. Results: The combination of adapalene and azithromycin caused the highest reduction in the inflamed lesion count followed by azithromycin given singly. Further, monotherapy with adapalene was used. However, this difference in efficacy was small and not statistically significant ( P = 0.717). Azithromycin lead to a rapid reduction in the inflammatory lesion count, but it had negligible action on noninflamed lesions. Conclusion: At the end of 12 weeks of treatment, the three treatment groups showed no statistically significant difference in the efficacy in inflammatory acne.

Background: Skin tags or acrochordons are common tumors of middle-aged and elderly subjects. They consist of loose fibrous tissue and occur mainly on the neck and major flexures as small, soft, pedunculated protrusions. Objectives: The aim was to compare the mast cells count in skin tags to adjacent normal skin in diabetic and nondiabetic participants in an attempt to elucidate the possible role of mast cells in the pathogenesis of skin tags. Participants and Methods: Thirty participants with skin tags were divided into group I (15 nondiabetic participants) and group II (15 diabetic participants). Three biopsies were obtained from each participant: a large skin tag, a small skin tag and adjacent normal skin. Mast cell count from all the obtained sections was carried out, and the mast cell density was expressed as the average mast cell count/high power field (HPF). Results: A statistically significant increase in mast cells count in skin tags in comparison to normal skin was detected in group I and group II. There was no statistically significant difference between mast cell counts in skin tags of both the groups. Conclusion: Both the mast cell mediators and hyperinsulinemia are capable of inducing fibroblast proliferation and epidermal hyperplasia that are the main pathologic abnormalities seen in all types of skin tags. However, the presence of mast cells in all examined skin tags regardless of diabetes and obesity may point to the possible crucial role of mast cells in the etiogenesis of skin tags through its interaction with fibroblasts and keratinocytes.

Pemphigus is an autoimmune blistering disease of the skin and mucous membranes with different reported epidemiological aspects from different countries. Aim: Our aim was to evaluate the epidemiological aspects of pemphigus in Mashhad city. This is the first report with regard to the characteristics of pemphigus in Khorasan province of Iran. Materials and Methods: In this cross-sectional study, all the patients with pemphigus, who were referred to the Dermatology Department of Imam Reza hospital of Mashhad, were examined over nine years, i.e., from May 1998 to March 2007. The data obtained through questionnaires, including age, sex, profession, mucosal or skin or the involvement of both, lag-time period between the onset of disease and the first presentation, gap between cutaneous and mucosal involvements, season of onset and family history, were analysed by using statistical tests of Chi square and Student's t -test and the statistical software of SPSS. Results: In 178 patients with pemphigus, pemphigus vulgaris was the most common type (86.5%). Female to male ratio was 1.4. In pemphigus vulgaris patients, there was involvement of both the skin and mucosa in 64.3%, mucosal involvement in 14% and skin involvement in 21.7%. There was no mucosal involvement in patients with pemphigus foliaceus. Two patients (1.4%) had a positive family history. Summer was the most common season for the onset of the disease (37.5%). Most of the patients were housewives in the premenopausal age group. Conclusion: The results reveal a high incidence of pemphigus in northeast Iran with an incidence of 20 patients per year.

Macular amyloidosis is a relatively common cutaneous disease in Asia and the Middle East. It is characterized by a reticulated or rippled pattern of pigmentation mostly in the upper back. This study was performed not only to determine the disease, sex and age distribution but also to evaluate its risk factors and the frequency among the patients in the dermatology clinic. In this study, 100 macular amyloidosis patients were evaluated in a period of 4 years.
The sex ratio (female:male) of the patients was 9:1, and the mean age of the female patients was higher than that of the males. We found no evidence of any other associated risk factors.

Study of contact dermatitis due to topical medicaments and cosmetics by patch testing

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Amit Vij, P Madava Murthy, K RavindraDOI:10.4103/0019-5154.37725

Background: Contact dermatitis is the most common immunological disorder encountered by the dermatologist and it arises when a person develops delayed type of hypersensitivity reaction to a substance coming in contact with his skin. The patch test is at present a helpful test for demonstrating contact type of allergy that identifies the cause of allergic contact dermatitis. Aim: To study the common topical medicaments and cosmetics capable of producing contact dermatitis and value of patch testing in these situations. Materials and Methods: One hundred patients suspected of having contact sensitivity to topical medicaments and common cosmetics were subjected to patch testing with the finished commercial product being used by the patient and the antigens of the Indian Standard Series and Cosmetic series kit. Results: Positivity with patch test of 96.65% was observed in patients with contact dermatitis to topical medicaments, whereas 85% of the patients with cosmetic dermatitis were tested positive. Among the cases with contact dermatitis to topical medicaments, Neomycin was tested positive in more number of patients and among the patients with cosmetic dermatitis; Kum-Kum powder and Fairness cream were tested positive in more number of patients. Conclusion: It is well known that topical medicaments are known to produce contact dermatitis; the cosmetics that are claimed to be very safe by their manufacturers do not stay much behind in doing so.

Mites belonging to Pyemotidae family are an important cause of human dermatoses. Though their bites are painless, yet, afterwards severe itching and possible secondary infection. Most of the time mites could not be demonstrated from the lesion. We are presenting a case where mites could be seen in scrapping from a typical lesion in man.

Mastocytosis is a condition characterized by the disorderly infiltration of mast cells in several tissues and comprises many different clinical situations varying from indolent cutaneous forms to malignant and systemic conditions. Bullous mastocytosis is a rare variant of cutaneous mastocytosis manifested by the diffuse infiltration of skin by mast cells, where cutaneous bullae is the predominant feature. We present this case for its rarity and diversity.

Centrifugal necrotic keratoacanthoma is a quite rare variant of keratoacanthoma, with a locally aggressive behavior and no tendency to spontaneous involution. We report a typical case of the nasal-orbital region. Based on its clinical, histological and behavioral picture, centrifugal necrotic keratoacanthoma appears as variant of giant keratoacanthoma and can be regarded as an intermediate form in a spectrum where keratoacanthoma and overt squamous cell carcinoma represent the most benign and the most malignant end, respectively, as also highlighted by analogies between the two lesions recently reported in the field of molecular biology.

Basal cell carcinoma (BCC) is the most common of the cutaneous malignancies, accounting for 65-75% of all skin cancers. The natural history of this disease is one of chronic local invasion. Metastatic BCC Is a rare clinical entity, with a reported incidence of only 0.0028-0.5%. Approximately 85% of all metastatic BCCs arise in the head and neck region. We present a case of BCC that spread to the muscles of the cheek and nodes (intraparotid and internal jugular), in a man who had a lesion near the inner canthus of his right eye and adjoining nasal bridge.